The Southern Primary-Care Urban Research Network (SPUR-Net) in Houston, Texas, is a participating member of the PRIME-Net Center of Research Excellence and Learning funded by an AHRQ P30 grant. The Department of Family and Community Medicine (DFCM) at Baylor College of Medicine is the academic home of SPUR-Net. Many SPUR-Net clinics have implemented electronic health records (EHRs) and begun participating in the meaningful use (MU) initiative under the HITECH act of 2009. DFCM SPUR-Net clinicians and researchers have focused a number of research and practice transformation efforts on meeting MU objectives, including utilization EHRs to meet patient engagement requirements and achieve desired outcomes among diverse subgroups of patients. We are therefore well prepared to provide empirical evidence and policy suggestions related to three Stage 3 MU patient engagement objectives. The goal of the project is to evaluate current utilization of patient engagement features of an widely implemented EHR (EpicCare) in primary care settings in order to provide data that will be useful in selecting Stage 3 MU criteria for the SGRP 205, 206, and 207. Targeting SPUR-Net clinics that use the same EHR program (EpicCare), we will achieve the following Specific Aims: (1) Describe: (a) the content of an existing sample of EpicCare After Visit Summary (AVS) Patient Instructions Sections generated during a previously funded project (AHRQ Task Order #17); (b) the relationship between AVS Patient Instruction Section content, including diagnosis-specific instructions, patient education materials, and non-English language materials, plus patient-reported outcomes(SGRP 205 AND 206). (2) Survey SPUR-Net primary care providers who use EpicCare about their knowledge, attitudes, and practices related to using the AVS Patient Instructions Section, including use of (a) smart phrases designed by the system; (b) smart phrases produced by the individual provider or practice; (c) non-English language materials; and (d) and patient characteristics that determine decisions about the content of patient instructions (SGRP 205 and 206). (3) Compare patients' utilization of a secure Web portal (the EpicCare EHR) to view their medical records and communicate with providers in a private practice vs. a public health care setting that serves uninsured and under-insured, predominantly minority patients. Variables to be examined in Aim 3 include: (a) proportion of NEW patients who register to use the Web portal after their initial visit; (b) time to first use of the Web portal after the initial visit; (c) frequency of using the eb portal during a specified interval; and (d) types of messages/requests sent (SGRP 207); (4) Disseminate the study findings using traditional modes, such as conference presentations and publications in peer reviewed journals as well as information technology channels, including a formal Webinar announced via appropriate distribution lists, and posting the results on the SPUR-Net and PRIME-Net Websites.